MPR's disturbing report on Minnesota Security Hospital

Minnesota Public Radio published a disturbing report Tuesday on what seems to be the deteriorating situation at the Minnesota Security Hospital in St. Peter, the state’s largest facility for individuals who are considered both mentally ill and dangerous.

The hospital’s problems are longstanding, but concerns about both patient care and employee morale have intensified since a new administrator, David Proffitt, took charge of the facility last August.

The use of restraints has more than doubled since Proffitt arrived. Employees describe a chaotic work environment made worse by confusing policies and a lack of adequate training. They said the turmoil has alienated employees and led to the exodus of the facility's top psychiatry staff.

In the meantime, the state has hired a private firm to investigate allegations by several psychiatrists that Proffitt created a hostile work environment and made sexually inappropriate comments.

[Minnesota Department of Human Services] Deputy Commissioner Anne Barry told MPR News the facility is now just a few missteps away from losing its license and being taken over by the U.S. Department of Justice, a result of mismanagement that set in before Proffitt took over.

The situation at the hospital took a decided turn for the worse last fall when Proffitt fired psychiatrist Dr. Michael Harlow after an incident during which a violent patient was put in seclusion, placed in handcuffs, and stripped naked.

That particular incident, even against a background of steady tumult, is repeatedly cited by staff as disorienting and paralyzing when it comes to everyday practices. Employees said they no longer know how they are supposed to respond to patients who are suicidal or homicidal. Instead, they said they’re left debating the meaning of confusing policies and worrying about getting fired, while patients wield weapons and threaten violence.

No debriefing

Here are a few of the more concerning details from Baran’s report:

Proffitt apparently failed to conduct an extensive debriefing of the staff members involved in last fall’s incident — a process considered standard protocol at other facilities around the country. Instead, Proffitt told Baran, hospital supervisors debriefed a few of the employees. Yet, as Proffitt also told Baran, he himself "did not keep track of whether staff members had been debriefed, …. did not meet with any of the staff members involved, other than a brief meeting to fire Harlow, and did not talk to the facility’s psychiatrists about the incident.” “National studies show that the facilities that are the most successful in reducing restraint and seclusion use incidents like these to help learn how to differently approach violent or upset clients should there be another incident,” writes Baran.

Proffitt told Baran that his action to fire Harlow was made on the recommendation of a four-person workplace incident review committee. Not so, a psychiatrist who served on that committee told Baran. The committee did not make any such recommendation, he said, and Harlow’s dismissal had come as a surprise to him.

Proffitt did not seem concerned that the police were called out to diffuse a frightening incident last Jan. 25. “A male patient was agitated,” writes Baran. “He began threatening other patients on the unit. The counselors considered asking to have the man placed in seclusion, but worried they would get in trouble. Instead, they said, they tried to calm the patient by talking to him. Their efforts failed.”

The man then armed himself with a weapon fashioned from a broken CD and pen and announced that he intended to take several patients hostage and kill certain members of the staff. The counselors called the St. Peter Police Department. When the officers arrived, they pointed a Taser at the patient, told him not to move, and then handcuffed him.

When asked about the incident,” writes Baran, “Proffitt said he was familiar with what happened, but his response raised questions about how the facility tracks serious incidents.”

“The St. Peter police department responded in an outstanding manner, came on the unit, explained the options to the client,” Proffitt said. “The client then agreed to put down the weapon and to go into the seclusion room.”

“I did not see that,” he said. “If it is reported, I didn’t get it, but that’s irrelevant from my perspective.”

Proffitt said that when patients have a weapon, employees are always instructed to call the police.

“It’s the best outcome we could’ve hoped for in a bad situation,” he said.

Employees disagreed. “You want to talk about psychologically harming a patient?” one security counselor said. “What’s more disturbing than a cop threatening to tase you?”

Similar concerns at last job

The concerns that Baran’s article raises about Proffitt’s leadership at the Minnesota Security Hospital are eerily similar to concerns that were expressed about him in regard to his last job, president and CEO of the Acadia Hospital in Bangor, Me.

Proffitt, who had headed up the 100-bed psychiatric hospital since the fall of 2008, came under fire in recent months from many employees, who charged that his policies aimed at eliminating the use of patient restraints led to a significant increase in work injuries at the hands of out-of-control patients. The complaints led to a federal investigation last year by the Occupational Safety and Health Administration, which identified a number of worker safety violations.

Proffitt also was criticized for an autocratic leadership style that allegedly undermined employee morale as well as patient care at the hospital, which formerly had been recognized as a high-performing “magnet” hospital by a leading nursing organization. He also was criticized for holding a dubious doctorate from a now-defunct online “diploma-mill.”

You can read Baran’s article on the MPR website. There’s also a short broadcast of her discussing the article with MPR host Tom Crann.